Musculoskeletal Injury Rehabilitation

There are many factors to consider when discussing the topic of musculoskeletal injury rehabilitation and injury care.

For example, many people underestimate the impact of mental health on musculoskeletal injury. A person’s attitude makes a tremendous impact on their rate of recovery. The relationship between the mind and physical health is a growing area of research, and the link between these two are no longer debated. Every case of injury recovery is different, and every person heals differently. The relative importance of tissue damage, psychological health and social status are different for every patient.

For the sake of keeping this blog entry simple, we’re just going to focus on the biological / tissue component of injury. As always, this is not specific advice but rather an effort to give the reader some insight into the thought process of managing many injuries. There are always exceptions to the rule.

Focusing on the Biological Component of Injury

Imagine a case in which a patient walks in our door to the clinic with an injury. We’ve identified a diagnosis that fits the description of her injury, and the examination findings are consistent with this. For example, the patient is a runner who sprained her ankle. The joint is swollen, and tender and passive inversion reproduces the pain in her lateral ankle. She wants to continue running. Unfortunately, every time she goes for a run the ankle hurts more and swells. It causes her to limp for a few days until it settles. What should she do? Although this may seem obvious to many people, it isn’t always so obvious. When an injury persists, it may persist for many different reasons. As mentioned earlier, an example could be the psychosocial factors that can impact injury recovery. In this example though, with respect to the tissue damage, this patient needs to ‘unload the tissue.’ She’s trying to recover from an injury that she is probably re-injuring at a very subtle level every time she goes for a run.

The body usually wants to heal. Cells regenerate for most conditions, and if we allow it, the body wants to heal on its own. We can often speed this up using modalities like laser, and we can assist in tissue remodelling through manual therapy and exercise prescription, but what can impede this process is continued stress on a tissue that does not have the capacity for that stress yet. Imagine a cut on your skin that is trying to heal, but you rip the scab off every few days. Running on a sprained ankle can be an example of continuing to challenge a damaged tissue beyond its present capacity and therefore delay recovery.

Employing ‘Relative Rest’

An important aspect of recovering from tissue injury is to ‘unload’ the tissue. We need to refrain from those activities, postures or exercises that seem to overload the damaged tissue beyond its capacity.

That doesn’t necessarily mean we completely rest, but instead, we usually employ ‘relative rest.’ This means the patient with the sprained ankle can still perform rehabilitative strength exercises, can still walk, hopefully, and perhaps even continue to train the cardiovascular system through a different method that doesn’t reproduce pain or worsen symptoms.

An example of this alternative training, this might be cycling. With the careful assistance of a professional, this patient might be able to cycle and get a good workout in without aggravating symptoms. This wouldn’t be a hard rule however but is an example of an activity that might allow tissue healing to continue without the risk of further damage.

Again, the first step is to not impede the damaged tissue from recovering. From there, we look to build up the function through exercises so that the area continues to adapt and have improved capacity for loading.

In a sense, we strip everything down and start again from scratch, keeping a careful watch on symptoms. If things seem to be worsening or regressing, we progressively challenge the tissue to the point that the person is content with their pain levels, get back at their regular exercise and that they have reduced the chance of future injury.